REPORTS AND STUDIES SUPPORT APN FULL PRACTICE AUTHORITY
National Governors Association (December, 2012). The Role of Nurse Practitioners in Meeting
Increasing Demand for Primary Care. Washington D.C.: Author.
“None of the studies in NGA’s literature review raise concerns about the quality of care offered
by NPs. Most studies showed that NP-provided care is comparable to physician-provided care
on several process and outcome measures. Moreover, the studies suggest that NPs may
provide improved access to care.”
Improving Access to Primary Care: The Growing Role of Advanced Practice Registered Nurses.
(2010). Washington, DC: AARP Foundation & Robert Wood Johnson Foundation’s Center to
Champion Nursing in America.
APRNs: Evidence of Quality
“Studies demonstrate that, for more than 40 years, consumers have been receiving safe and
effective health care from APRNs. In fact, research shows no difference in outcomes of primary
care delivered by a nurse practitioner or a physician, including patient health status, number of
prescriptions written, return visits requested, or referrals to other providers. No study
establishes a basis for requiring that physicians supervise APRNs.”
Fleming, C. (2010, October 25) Health Policy Affairs Brief: Nurse Practitioners and Primary
Care. Health Affairs Blog.
“With a predicted shortage of primary care as the population grows as millions of people
become newly insured starting in 2014, one proposed solution is to expand the role of nurse
practitioners in many more areas of the county, and to allow them to provide a wider range of
preventive and acute health care services.”
“Studies comparing the quality of care provided by physicians and nurse practitioners have
found that clinical outcomes are similar. For example, a systematic review of 26 studies
published since 2000 found that health status, treatment practices, and prescribing behavior
were consistent between nurse practitioners and physicians.”
Fairman, J.A. et al. (2011, January 20). Broadening the Scope of Nursing Practice. New
England Journal of Medicine, 364, 1-4.
“This is a critical time to support an expanded, standardized scope of practice for nurses.
Economic forces, demographics, the gap between supply and demand, and the promised
expansion of care necessitate changes in primary care delivery. A growing shortage of primary
care providers seems to ensure that nurses will ultimately be required to practice to their
fullest capacity. Fighting the expansion of nurse practitioners’ scope of practice is no longer a
defensible strategy. The challenge will be for all health care professionals to embrace these
changes and come together to improve U.S. health care.”
The Institute of Medicine (2010). Future of Nursing: Leading Changes, Advancing Health.
“The current conflicts between what APRNs can do based on their education and training
and what they may do according to state and federal regulations must be resolved so that
they are better able to provide seamless, affordable, and quality care.
The eight recommendations offered in the report are centered on four main issues:
1. Nurses should practice to the full extent of their education and training.
2. Nurses should achieve higher levels of education and training through an improved
education system that promotes seamless academic progression.
3. Nurses should be full partners, with physicians and other health professionals, in
redesigning health care in the United States.
4. Effective workforce planning and policy making require better data collection and
information infrastructure.”
Newhouse, R.P., et al. (2011). Advanced Practice Nurse Outcomes 1990-2008: A Systematic
Review. Nursing Economics$, 29 (5), 230-250.
“A 19-year review that shows that care provided by CNMs (compared to physician care for
women of the same risk level) is shown to have lower rates of cesarean section and many other
interventions that increase costs without increasing quality of care.”
Co-Chairs’ Summary of Conference: Who Will Provide Primary Care and How Will They Be
Trained? (2010, January). New York, NY: Josiah Macy, Jr. Foundation.
Recommendation 2
“Coupled with efforts to increase the number of physicians, nurse practitioners, and physician
assistants in primary care, state and national legal, regulatory, and reimbursement policies
should be changed to remove barriers that make it difficult for nurse practitioners and
physician assistants to serve as primary care providers and leaders of patient-centered medical
homes or other models of primary care delivery. All primary care providers should be held
accountable for the quality and efficiency of care as measured by patient outcomes.”
Barbara J. Safriet, J.D., L.L.M. (2011). Federal Options for Maximizing the Value of Advanced
Practice Nurses in Providing Quality, Cost-Effective Health Care. Washington, D.C.: The
National Academy of Sciences.
“Freeing APNs from the unnecessary constraints I have identified (which are at bottom nothing
more than the historical artifacts of medical preemption) will achieve two important objectives.
First, it will better enable Americans, wherever they are situated, to receive much-need health
services at a cost they can afford. Second, it will begin to remedy the systemic unfairness that
has distorted many aspects of the healthcare delivery system, and will serve as a model for
comprehensive reform of our entire regulatory framework by focusing on the evolving ability
and competence of all providers rather than on rigid proprietary prerogatives.”
Hagen, P. et al. (2010, May/June). Cost Effectiveness Analysis of Anesthetic Providers.
Nursing Economic$, 28 (3), 159-169.
“Anesthesiologists and CRNAs can perform the same set of anesthesia services, including
relatively rare and difficult procedures such as open heart surgeries and organ transplantations,
pediatric procedures, and others. CRNAs are generally salaried, their compensation lags behind
anesthesiologists, and they generally receive no overtime pay. As the demand for health care
continues to grow, increasing the number of CRNAs, and permitting them to practice in the
most efficient delivery models, will be a key to containing costs while maintaining quality care.”
Pittman, P. & Williams, B. (2012). Physician Wages in States with Expanded APRN Scope of
Practice. Nursing Research and Practice, 1-5
“Our findings…suggest that, at least among employed primary care physicians, expanded SOP
laws do not impact their earnings… In fact, wages for all three practitioner groups rose at a
slightly faster rate between 1999 and 2009 in states with more liberal SOP laws in states with
restrictive laws.”
Dulisse and Cromwell, No Harm Found When Nurse Anesthetists Work without Supervision
by Physicians, Health Affairs, August 2010, 29:8
“37,000 certified registered nurse anesthetists provide thirty million anesthetics annually in the
United States and represent two-thirds of anesthetists in rural hospitals.”
National Association of Community Health Centers. (2008, August). Building a
Primary Care Workforce for the 21st Century. Washington, DC
“State scope of practice standards set the boundaries by which key primary care providers,
namely NPs and PAs, can deliver care. State policymakers must consider how these standards
encourage or discourage primary care professionals to locate in and form teams in underserved
areas. Some states, including Colorado and Pennsylvania, have dealt with primary care
shortages in underserved areas by expanding scope of practice for NPs, PAs, CNMs, nurses, and
dental hygienists. If health centers are to form medical or health care homes and maximize
quality and efficiency, policies that facilitate team functions for patients will be needed.”
Robin P. Newhouse, et al. (2011, September-October). Advanced Practice Nurse Outcomes,
1990-2008: A Systematic Review. NURSING ECONOMIC$(29) 5, 1-22
“This systematic review supports a high level of evidence that APRNs provide safe, effective,
quality care to a number of specific populations in a variety of settings. APRNs, in partnership
with physicians and other providers, have a significant role in the promotion of health.
American health care professionals will need to move forward with evidence-based and more
collaborative models of care delivery to promote national unified health goals.”